FIGURE 5 | Pathological findings observed in renal biopsy samples obtained after the first year post-transplantation.

From the following article:

Clinical role of the renal transplant biopsy

Winfred W. Williams, Diana Taheri, Nina Tolkoff-Rubin & Robert B. Colvin

Nature Reviews Nephrology 8, 110-121 (February 2012)

doi:10.1038/nrneph.2011.213

Clinical role of the renal transplant biopsy

a | Chronic AMR is characterized by duplication of the glomerular basement membrane, which is best observed in periodic acid–Schiff-stained sections. Inset image: C4d deposition (blue staining) is usually present in peritubular capillaries (stained brown with CD34, an endothelial marker) but can be focal, with only a minority of the peritubular capillaries affected, or even absent. b | The multilaminated glomerular basement membrane (black arrow) in chronic AMR can be observed by electron microscopy, which also reveals the loss of normal fenestrations in glomerular endothelial cells (red arrow). c | The most distinctive feature of calcineurin inhibitor toxicity in renal grafts ≥1 year after transplantation is severe hyalinosis of the arterioles, often with a peripheral nodular pattern (arrows). d | De novo focal segmental glomerulosclerosis can occur at any time after renal transplantation, but is most common ≥1 year after transplantation. Focal segmental glomerulosclerosis can also be a manifestation of the toxic effects of calcineurin inhibitors, which in this image shows a collapsing pattern with prominent podocytes (arrow). Abbreviation: AMR, antibody-mediated rejection. Permission obtained from Amirsys © Colvin, R. B. et al. Diagnostic Pathology: Kidney Diseases (Salt Lake City, 2011).

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